Amos Bailey M.D. took the lead in founding “Balm of Gilead,” the only hospice or comfort care organization in the state of Alabama. Along with Edwina Taylor, a nurse, and other associates, Dr. Bailey primarily serves the working poor of Birmingham and the underinsured. This health care team tries to help terminally ill people to die peacefully, with opportunities to attend to personal and spiritual issues.

These compassionate and creative medical professionals appear in the fourth section of Bill Moyers’ new series “On Our Own Terms.” The first program will be shown starting this month on public television stations across the country. Convinced of the series’ importance, the stations have mounted a major publicity drive and have organized community groups to discuss vital questions raised by the programs.

Dr. Bailey wants to change the culture of dying. His effort is to control the pain of his patients so that they can make good end-of-life choices and also attend to important personal issues. He aims at stabilizing the condition of patients so that, if at all possible, they can go home to die.

As Bill Moyers explains, that’s where most Americans wish to spend their last days. Statistics show, however, that four out or five of us die in hospitals or nursing homes. To change this reality requires reformers to go against many different obstacles, as Dr. Bailey has discovered.

At Balm of Gilead, top priority goes to relief of suffering. That includes four different kinds of suffering: physical, emotional, spiritual, and social. If physical suffering is not controlled, Dr. Bailey emphasizes, then it is impossible for patients to concentrate on anything else. But then, the other kinds of suffering pose challenges, too. As Bill Moyers says, “There are no charts for soul pain.”

Dr. Bailey and his associates like to consider control of pain as a person’s fifth vital sign, the others being blood pressure, body temperature, pulse, and respiration.

The team also is committed to avoiding invasive medical treatment such as oxygen masks that cover the face. And, for these patients, they do not recommend surgery or other drastic means for prolonging life.

These health care providers, instead, spend much of their time talking and listening. As Edwina Taylor says of her patients, “It’s such a powerful thing for them to know that they have someone standing with them, that it’s okay to talk about dying.”

John Reagan, age 85, one of Dr. Bailey’s patients, could not stay at home because he could not handle his own medications. This resulted in his being sent to a nursing home where regulations at first did not allow Dr. Bailey to continue to take care of Mr. Reagan.

Another of his patients, Mrs. James, will have to leave his care if she takes too long to die because Medicare covers only six months. Still another, Portia Boyd, needs to employ a woman to prepare meals but Medicare will not pay for this vital chore. Dr. Joanne Lynn, another pioneer in end-of –life care, is heard to complain, “I can get any patient into the ICU (intensive care unit), but I can’t get a meal delivered on the weekend.”

Another chief obstacle to a shift in priorities does not directly concern insurance coverage. Rather, it is the lack of training of most doctors in pain control and end-of-life issues. Too many of them give their main attention to the illness instead of the person. As Edwina Taylor, a nurse with 29 years’ experience says, “A lot of doctors cannot admit that a patient will die.”

Things are changing, however. One half of Americans who die of cancer now do so with the assistance of a hospice program. This fact suggests that more and more people recognize, among other things, the importance of spiritual issues as one prepares for death.

The Massachusetts Compassionate Care Coalition, a group of 140 people from forty different organizations, aims to improve care of the dying. Founded two years ago, this coalition tries to help people become aware of good end-of-life care and of the decisions that need to be made then.

Carol Wogrin, MCCC’s spokeswoman, says of those involved in this end-of-life care, “People don’t work with the dying just because they need a job; for whatever reason, they feel compelled.”

To judge from the television series, these words aptly describe Dr. Bailey, Ms. Taylor and the other team members at Balm of Gilead in Birmingham.

Richard Griffin